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VOL.6 NO.2
J U N E / J U LY 2 0 0 7
THE NEWSLETTER OF COLUMBIA UNIVERSITY MEDICAL CENTER
The College of Physicians & Surgeons • The College of Dental Medicine • The School of Nursing • The Mailman School of Public Health
The Coordinated Doctoral Program in the Basic Sciences of the Graduate School of Arts & Sciences
H I V
I N
N Y C
Researchers on Battlefront
Of Local HIV Epidemic
N E W G R A N T S F U N D C L I N I C A L T R I A L S F O R N E X T- G E N E R AT I O N P R E V E N T I O N , T R E AT M E N T
W
ith 64 percent of the world’s
HIV-positive people, subSaharan Africa is the location most often thought of as the epicenter of the HIV/AIDS epidemic, so much
so that the epidemic in the United States
is often forgotten.
“There is a widespread misperception
that HIV is under control here, but the
HIV incidence in some New York City
populations is higher than in many
African countries,” says Wafaa El-Sadr,
M.D., professor of clinical medicine and
epidemiology and chief of infectious diseases at Harlem Hospital.
Two new grants recently awarded to
Dr. El-Sadr and Scott Hammer, M.D., the
Harold C. Neu Professor of Infectious
Diseases, will allow Columbia to continue to focus needed attention on the
HIV/AIDS epidemic in New York City.
With support from a $20 million,
seven-year grant from the NIH, the
Source: NYC Department of Health & Mental Hygiene, 2007
People with HIV as a percentage of population in
2005. The South Bronx, Central Brooklyn, Harlem,
and lower Manhattan have the highest proportions
Columbia Collaborative HIV/AIDS
Clinical Trials Unit, led by Dr. Hammer,
provides New Yorkers with access to the
latest drugs and vaccine candidates in
clinical trials. A highlight of this grant is
the close collaboration of adult and
pediatric clinical HIV research at CUMC
with Philip LaRussa, M.D. professor of
clinical pediatrics, as the principal investigator of the latter.
An additional $3 million, seven-year
grant will help the Center for Innovative
Research to Control AIDS, directed by
Dr. El-Sadr, test ways other than vaccines
to prevent HIV transmission.
Both grants were awarded in March
as part of a reorganization of the
HIV/AIDS clinical trials networks of the
National Institute of Allergy and
Infectious Disease (NIAID). Columbia
has been a part of the networks since
1987, when the networks were estabplease see Page 7
of people living with HIV in the city.
L E A D E R S H I P
C O N T E N T S
n
n
HIV in New York: CUMC Physicians in
the Trenches
School of Nursing Leads in Primary
Care, Education and Research
EVP Column: A Year of Progress
1 School of Nursing Becomes
National Trendsetter
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3A
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C O L U M B I A - T R A I N E D N U R S E S F I L L P R I M A RY C A R E G A P, E N G A G E I N
GROUND-BREAKING RESEARCH
Ethical Implications of a
Pandemic Flu
n
n
P&S Scientists Pinpoint Neuronal
Culprits in ALS
New Lyme Center Launches
Craniofacial Surgeons
Repair Young Lives
n
n
Research Briefs
Mailman Researchers Join Hunt
for Killer of Bees
Awards & Honors
recent study led by a team of
researchers from the School of
Nursing found that in intensive care units at hospitals across the
country patients are more likely to
acquire potentially deadly infections
where there is inadequate nurse staffing.
The study showed that an increase in
nurses’ overtime hours was linked to
higher rates of ventilator pneumonia,
catheter infections and skin ulcerations.
“Nurses are the hospitals’ safety officers, but nursing units that are understaffed and have overworked nurses are
shown to have poor patient outcomes,”
says Patricia Stone, Ph.D., M.P.H., R.N.,
assistant professor of nursing and the
study’s lead author. “Improvements in
nurse working conditions are needed for
the safety of our nation’s sickest patients.
With the looming nursing shortage, hospitals direly need to address working
conditions to help retain current staff
and recruit people into nursing.”
This work by Dr. Stone is one of
many patient care and health policy
studies that researchers at the school are
working on. (See sidebar on p. 8 for a
sampling). The school is at the forefront
of education advances as well, having
just graduated its second class of students with the Doctor of Nursing
Practice (DrNP) degree. These 20 clinical experts – all experienced nurse practitioners when they entered the program
– now have additional education and
skills necessary to care for patients in a
variety of settings, from hospital to
ambulatory care clinic.
The DrNP program is the first of its
please see Page 8
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C O L U M B I A
M E D I C A L
U N I V E R S I T Y
E V P
J O U R N A L
C E N T E R
Dear Colleagues & Students,
M
y first year at Columbia has been extraordinarily rewarding. I am personally grateful for the support of the collec-
InVivo is published by the Office of Communications and
External Relations. InVivo covers the latest advances and
news at Columbia University Medical Center.
LEE GOLDMAN, M.D., Executive Vice President for Health
tive Columbia University Medical Center community. Several initiatives have focused on creating a true CUMC
community. The deans of the Mailman School of Public Health (Dr. Allan Rosenfield), the College of Dental
Medicine (Dr. Ira Lamster) and the School of Nursing (Dr. Mary Mundinger) now serve officially as vice presidents of CUMC.
and Biomedical Sciences and Dean of the Faculties of Health
We meet together regularly to address issues and common interests and concerns. Using philanthropic funds, we conducted a
Sciences and Medicine
MARILYN L. CASTALDI, Chief Communications Officer
BONITA EATON ENOCHS, Assistant Vice President for
competitive process to encourage submission of proposals for four-school research projects. The winning proposal, “The Impact
of Social Inequities on the Complex Relationship between Oral Health and Peripheral Vascular Disease: An Interdisciplinary
External Relations and Director of Publications
Evaluation,” selected from among 14 applications, will be supported by the David A. Gardner New Initiatives Fund, created by
EDITORIAL STAFF
Board of Visitors member Lynn Shostack in memory of her husband.
ANNA SOBKOWSKI, Director of Science Communications
For P&S, it was a year of transition and a year of many accomplishments. We achieved strategic growth through the recruit-
and Editor
ment of many outstanding senior faculty whose expertise and professional breadth are already complementing our scientific and
SUSAN CONOVA, Science Writer
InVivo
clinical work. A new Department of Neuroscience and the new
701 West 168th Street, P&S Box 153
Center for Human Genetics are prime examples of organizing for
New York, NY 10032
Phone: 212-305-7131; Fax: 212-305-4521
greater potential. Similar initiatives are just starting in transplantation and in cardiovascular research. Our clinical research hub
for the campus, the newly renamed Irving Institute for Clinical & Translational Research, has become a central internal funding
[email protected]
www.cumc.columbia.edu/news/in-vivo
agency, helping to drive multi-department, multi-school clinical research across the medical center. P&S graduate programs,
Design: Graphic Expression Inc., NYC
which are already highly rated for their excellence by the Chronicle of Higher Education, are being reshaped to enrich cross-disciplinary exposure consistent with current research trends. The M.D./Ph.D. program is expanding, thanks to renewed and
E D U C A T I O N
increased NIH funding.
Teaching Academy
Announces 2007
Research Grants
The Glenda Garvey Teaching Academy at CUMC provides support for innovative educational research projects, particularly those that involve more than one
school or that can be generalized to all schools. Grants
are worth as much as $20,000 and can last two years.
Recipients of 2007 educational grants and their
This year the Mailman School of Public Health fortified its position as a leader in global health, with research and service programs in more than 80 countries. The school’s International Center for AIDS Care and Treatment Programs, (ICAP), recipient
of the largest government grant in Columbia University history, provided HIV/AIDS care through ICAP-supported sites to more
than 250,000 people in Africa and Thailand. The Reproductive Health Access, Information and Services in Emergencies initiative, a program addressing a full range of reproductive health needs for refugees and internally displaced persons, launched with
the largest foundation grant in Columbia’s history. Two new centers – the Center for Study of Social Inequalities and Health
(Departments of Epidemiology and Sociomedical Sciences) and the Imprints Center for Genetic and Environmental Lifecourse
Studies (Department of Epidemiology) – were established to provide greater understanding of the origins and influences affecting health and disease.
Innovations at the College of Dental Medicine are expanding the scope of traditional dental research. An NIH-funded initia-
projects:
tive is exploring the promise of stem cells to create soft tissue for craniofacial reconstruction. Faculty are leading research into
RONALD
B AY E R ,
PH.D.,
professor of socio-
lasers and new imaging techniques that will transform dental care in the future and are offering instruction on use of new techmedical sciences, Mailman School of Public Health.
nologies in patient care. The College has continued to be a leader on national healthcare policy, advocating for expanded oral
“Development of a Health Sciences-wide Course on
healthcare for both children and the elderly. Globally, dental faculty and students are working to develop sustainable oral health
the Ethics of Public Health.”
programs in Sub-Saharan Africa through the Millennium Villages program, while continuing with many active local public servH E E R A C H A N G , M . D . , D . D . S . , assistant pro-
ice programs like the Community DentCare Network.
fessor of oral and maxillofacial surgery, College of
The School of Nursing enjoyed unprecedented growth this year in record numbers of students applying and being admitted.
Dental Medicine. “Case Based Learning for the
Research faculty continues to achieve prominence as leaders in areas of national priorities in science. The school ranks first in
Management of Medically Compromised Patients in
NIH per capita funding and 13th in aggregate funding (up from 27th in 2006). Clinical practice is distinguished with the Doctor
Dental Practice.”
of Nursing Practice (DrNP) degree – developed and instituted first at Columbia – now being adopted by over 200 schools of
W E N D Y C H U N G , M . D . , P H . D . , assistant pro-
nursing. The third class of DrNP students graduated in May, and all are actively engaged in advanced practice.
fessor of pediatrics, P&S. “Conversations in Genetics:
A key factor in ensuring the continued evolution and invigoration of our research, education, and clinical initiatives will be
Development of Educational DVDs to Teach Medical
the opportunity to grow physically as well as programmatically. Even as we embark on a comprehensive space planning process,
Genetics.”
we are working on plans to expand classroom space within the Hammer building to benefit all four schools.
N I C H O L A S F I E B A C H , M . D . , professor of clinical
medicine; J O H N E N C A N D E L A , P H . D . , director,
My thanks to the CUMC community for its support and inspiration during my first year at Columbia. I wish you all an enjoyable summer as we continue our commitment to making CUMC arguably the best in all that we do.
Scholarly Resources; K A T H E R I N E N I C K E R S O N ,
M.D.,
associate professor of clinical medicine;
A N D R E W M U T N I C K , M . D . , assistant clinical pro-
fessor of pediatrics, P&S. “Improving House Staff
Teaching of Medical Students: Learning to Give
Effective Feedback in the Clinical Setting.”
please see Page 6
2
Lee Goldman, M.D.
H E A L T H
P O L I C Y
&
E T H I C S
C R A N I O F A C I A L
R E S E A R C H
If Pandemic Flu Strikes, Who Will
Get Scarce Ventilators?
Creating Implants
from Stem Cells
While many of us are trying to lose fat this summer,
researchers in the College of Dental Medicine will be
If a pandemic similar to the 1918
“Spanish” flu hit New York today, the state
projects more than 770,000 people would
be admitted to the hospital during a sixweek outbreak. Of those, nearly 60,000
would need mechanical ventilators.
The state has a stockpile of ventilators,
but in a severe pandemic, the demand
would outstrip the supply. Adding more
ventilators to the stockpile would not solve
the problem because severe staff shortages
are projected, and there would not be
enough workers to operate all ventilators.
Last year, the New York State
Department of Health and the New York
State Task Force on Life & the Law assembled a group of physicians, lawyers, ethicists and policymakers to draft a plan for
fair allocation of ventilators during an
emergency.
The plan calls for hospitals to triage all
patients and deny ventilators to those who
score poorly on an assessment that predicts
mortality. Many patients on ventilators at
the beginning of the pandemic would be
taken off against their wishes. (Full details
of the plan are available at http://www.
health.state.ny.us/diseases/communicable/influenza/pandemic/ventilators/).
After the state’s plan was presented to
CUMC faculty at a special town meeting
sponsored by the Center for Bioethics,
InVivo spoke with Neil Schluger, M.D.,
chief, Division of Pulmonary, Allergy, and
Critical Care Medicine and professor of
medicine, epidemiology and environmental health sciences, who was a member of
the working group that drafted the plan.
trying to devise ways to add fat back to our bodies.
With a new $2.5 million grant from the National
Institute of Biomedical Imaging and Bioengineering,
Jeremy Mao, D.D.S., Ph.D., associate professor of
dental medicine, will try to construct soft adipose
tissue implants out of a patient’s own stem cells.
Cancer surgery, chronic diseases, trauma and congenital anomalies can all cause disfigurements that
lead to physical and psychosocial suffering. During
reconstruction, surgeons will often graft soft tissue
from other sites on the patient’s body, but that creates additional wounds. Attempts have been made
to use fat cells left over after liposuction, but these
cells have a limited lifespan and the implants essentially deflate within weeks.
Dr. Mao’s plan is to create long-lasting soft tissue
implants from mesenchymal stem cells harvested from
In the winter of 1918, a new influenza virus spread around the world, killing 40 million
the patient’s own tissues such as bone marrow or adi-
to 50 million people and possibly as many as 10 percent of the world’s young adults.
pose tissue. Mesenchymal stem cells can differentiate
The plan addresses this potential problem by only pitting a patient against his
or her own chance of survival, not
against that of another patient’s. That
takes a bit of the burden away from the
doctor. Still, physicians would be the
ones turning off the ventilators. I’ve had
to withdraw care from a few patients
who subsequently died. In certain cases
it is the right thing to do, but few things
in medicine have shaken me up as much
as having to do that.
Does the plan violate doctors’ basic
What prevents healthcare providers
duty to care for their patients?
from ignoring the plan?
There is a real tension here. In medicine
you have an absolute obligation to your
patient, regardless of what is happening
to other patients in the hospital. This
plan is radically different and takes a
public health approach, where the focus
is on the community rather than on the
individual.
The plan asks physicians to do what
we generally don’t do – and don’t like to
do: deny or withdraw care. There are
times when we withdraw care if we think
further medical intervention is completely futile. But if we start rationing
ventilators, we would need to withdraw
or withhold care over the stated wishes
of the patient or the patient’s family. Will
physicians be able to do that? I don’t
think anybody is sure what is going to
happen.
The plan is totally voluntary. It has no
chance of working unless all hospitals in
an affected area play by the same rules.
Presumably, the governor would declare
a state of emergency and put the plan in
effect, but every hospital would still have
to agree to it.
A massive educational campaign will
have to be undertaken to help physicians
and the public understand that more
deaths would result from not following
the plan and that it is fairest for everyone. It doesn’t favor the wealthy, the
young, or the better educated. None of
those factors – even to the point of not
favoring healthcare workers if they got
sick, because they would be out of work
for months, just like everyone else – will
increase a patient’s access to a ventilator.
What happens to people who are
Is there anything in the plan that will
not eligible for a ventilator or are
make this any easier on physicians?
removed from a ventilator?
The plan is very careful not to pit one
patient against another. This is an issue
that always comes up in medical ethics
sessions. Nobody wants to abandon one
patient for a supposedly worthier one.
They would require palliative care. It
would be horrible not to give someone a
ventilator and then also not provide further care. But palliative care is not something that hospitals have a lot of expert-
ise with. Improving palliative care capacity is going to be a real challenge.
Have there been any medical
advances since 1918 that might make
a similar virus less lethal today?
Probably not. Our medical arsenal today
consists of immunization and treatment.
Immunization is not yet a realistic possibility. Making a vaccine for a pandemic
influenza is more difficult than making
one for regular influenza, and a vaccine
specific for the virus would not be available for at least six months after a pandemic starts. On the treatment side,
there’s Tamiflu. Nobody knows how this
drug will work in a pandemic. In studies
with regular flu, patients who took the
drug experienced, on average, one fewer
day of symptoms. I don’t think this is
going to save many lives.
The two most important advantages
we have today are surveillance and containment. Local, national, and international agencies are closely monitoring
domesticated animals. Birds infected
with avian flu are killed, and that may be
having some effect. In Vietnam, there
haven’t been too many cases lately of
avian flu in humans. We also know how
to quarantine more effectively, limiting
the activities of people who have been
exposed to a sick patient to try to prevent
them from spreading the disease.
Somewhat reassuring is the fact that
avian flu has not yet developed a great
capacity to spread from person to person. Maybe we’ll get lucky with avian flu
and it won’t cause a pandemic. But there
is always the next thing around the bend
that no one has yet heard of. We won’t be
lucky forever.
into bone, fat, cartilage and other types of cells.
Using a patient’s stem cells, Dr. Mao says, results
in replacement tissue that is completely compatible
with the patient. Stem cells also can replenish the
supply of cells in the implant to prevent shrinkage.
Dr. Mao’s team of biologists, biomedical engineers, imaging experts, and surgeons has already
shown that it can use human mesenchymal stem cells
to create a long-lasting implant. The implant is created by placing these stem cells into an FDA-approved
scaffold that mimics the conditions needed to turn
the stem cells into fat cells.
Dr. Mao found that when implanted into mice the
stem cells successfully created fat cells and that the
implants can retain their size and shape for at least a
month. Because the implants can be molded into any
size or shape, they may be used in the future for
facial and breast reconstruction. Dr. Mao’s team has
also been able to reconstruct the shape and dimensions of the bioengineered tissue from images of the
patient’s soft tissue defects.
Dr. Mao says his interest in soft tissue bioengineering grew out of his previous studies on mesenchymal
stem cells and an unmet clinical need for biologically
derived approach to reconstruct soft tissue. “The
implants can be used for multiple purposes, but it’s
really the soft tissue defects resulting from breast cancer surgeries and facial tumor surgeries that we want
to be able to heal one day,” Dr. Mao says.
— Susan Conova
3
N E W
C E N T E R
First-of-its-Kind Center
to Study Chronic Lyme
The Lyme & Tick-borne Diseases Research Center, the
N E U R O S C I E N C E
Toxins Released from Astrocytes
Found to Kill Motor Neurons in ALS
first university center for the study of Lyme disease in
the United States, has been created at CUMC. The
center, with the ongoing support of Time for Lyme
Inc. and the Lyme Disease Association, brings together a multi-disciplinary team of CUMC physician-scientists who employ the most recent advances in medical technology to help unravel the complexities of
Lyme and tick-borne diseases.
Lyme disease is the fastest growing organismtransmitted disease in the United States. New York,
New Jersey, Connecticut and Pennsylvania accounted for 64 percent of all cases of Lyme disease
reported to the CDC last year. May through August
are the peak months for contracting Lyme disease.
Located within the New York State Psychiatric
Institute, the center is headed by Brian Fallon, M.D.,
M.P.H., associate professor of psychiatry. It focuses
on clinical research to develop novel therapies,
basic science to unravel disease mechanisms and to
A
strocytes, cells that usually
nourish neurons, are responsible for the death of motor neurons in at least some cases of amyotrophic lateral sclerosis (ALS), according to a
study led by Serge Przedborski, M.D.,
Ph.D., co-director of Columbia’s Center
for Motor Neuron Biology and Disease.
The findings represent a shift in
knowledge about ALS, a fatal disease that
affects about 30,000 people in the United
States. People with ALS become increasingly paralyzed as their motor neurons,
which control movement, degenerate
over the course of the disease.
Until now, scientists have not known
which cells to blame for the deaths: the
motor neurons themselves, neighboring
cells, or a combination of both. The new
research steers the blame to a toxin
released by neighboring astrocytes. It
was published in the May issue of Nature
Neuroscience, alongside an independent
Harvard study that found
similar results.
The researchers – including postdoctoral fellows Makiko Nagai, M.D., Ph.D.,
Diane Re, Ph.D., and Tetsuya Nagata,
“There has, perhaps, been too much
emphasis placed on using embryonic
stem cells as replacements for cells killed
M.D., Ph.D. – and Alcmene Chalazonitis,
Ph.D., senior research scientist in anatomy & cell biology, discovered the toxin in
experiments with cells from mice with a
rare form of ALS. In this form of ALS,
the disease is caused by a mutation in the
superoxide dismutase gene (SOD1),
which is responsible for only a small percentage of cases in people, but is the sole
known cause of the disease.
To identify which cell causes motor
neurons to die, the researchers mixed
and matched ALS motor neurons and
astrocytes with the same cells from normal mice. The ALS motor neurons
thrived when paired with normal astrocytes, though they were slightly smaller
than usual. Normal motor neurons, in
by neurodegenerative diseases,” says coauthor Hynek Wichterle, Ph.D., assistant
professor of pathology, who developed
the technique used to coax embryonic
stem cells into motor neurons. “Because
embryonic stem cell derived motor neurons can be generated in large quantities
they will initially serve as a useful tool to
identify the toxin produced by astrocytes
and to discover new drugs that can save
neurons.”
ALS researchers at CUMC have
already started such investigations. Tens
of thousands of compounds are being
screened for their therapeutic potential
by Christopher Henderson, Ph.D., codirector of the Motor Neuron Center
and professor of
contrast, died when paired with ALS
pathology.
identify better diagnostic tests, and education of
medical students and physicians on how to best
evaluate and treat patients.
The center’s renowned collaborating scientists include Dr. Claire Fraser (led the team that
mapped the Borrelia genome), Dr. Janis Weis
(pathogenesis of Lyme arthritis), Dr. John
Mann (translational neuroscience), Dr. Steven
Schutzer (novel diagnostic tests), Dr. Ian Lipkin
(foreign pathogen identification), Dr. Jorge
Benach (Borrelia and co-infections), Dr. Scott
Photo: Charles Manley
Hammer (infectious diseases), Dr. Diego Cadavid
(neuropathology and neurology), Dr. Ronald Van
Heertum (neuroimaging), and Dr. Aaron Mitchell
(molecular pathogenesis).
The center is developing a brain bank for autopsy specimens from patients with neurologic Lyme
disease to study the neuropathology of the disease.
Dr. Fallon and his team recently completed a PET
imaging study of chronic Lyme disease, which highlights ways that functional brain imaging can be
used to identify biomarkers with potentially valuable diagnostic and treatment implications for
patients with chronic Lyme disease.
Lyme disease, when diagnosed and treated early,
is rarely a problem. When early diagnosis is missed,
the manifestations can be diverse and treatment
more complex.
For more information on Lyme disease research
at CUMC, visit: http://www.columbia-lyme.org/.
4
ALS research team, from left: Diane B. Re, Alcmene Chalazonitis, Serge Przedborski, Tetsuya Nagata and Hynek Wichterle.
The new discovery may open new
avenues for diagnosis and treatment.
“If our experiments faithfully model
the situation occurring in ALS patients,
then we can envision that blocking the
putative toxin produced by mutant
astrocytes may be effective in slowing the
progress of this disease,” says Dr.
Przedborski, who is also Page and
William Black Professor of Neurology
and professor of pathology and cell biology. “The presence of an astrocytic toxin
also suggests that embryonic stem cells
once placed into an ALS spinal cord to
replace lost motor neurons will be subjected to a deadly environment. Thus,
optimal response to such repair procedures may have to involve concomitant
administration of drugs capable of abating the astrocytic toxicity.”
astrocytes or with the ALS astrocyte’s
culture medium.
“It is like growing up in a bad neighborhood,” Dr. Przedborski says. “The
ALS astrocytes create a bad neighborhood that has a negative influence on
otherwise good neurons.”
The neighborhood was just as bad for
motor neurons derived from embryonic
stem cells, the researchers discovered.
When paired with toxic ALS astrocytes,
about half of the embryonic stem cellderived neurons died, matching the
death rate of natural motor neurons.
Without strategies to protect motor
neurons from the toxin, new neurons
introduced into a patient will most likely suffer the same fate as their natural
predecessors.
Dr. Przedborski’s lab is working to identify the unknown toxin, or toxins.
There are still many questions to
answer, however, before it is known
whether astrocytes play a deleterious role
in all ALS patients, most of whom have
normal SOD1 genes.
“We do not know yet if astrocytes in
patients with normal SOD1 release a
toxin,” Dr. Przedborski says. “If the
answer is yes, then our findings could be
a critical piece of the puzzle, but we still
have a long way to go.”
The research was supported, in part, by
the Muscular Dystrophy Association’s
Wings
Over
Wall
Street,
the
ALS
Association, Project ALS, the NIH, U.S.
Department of Defense, the Parkinson’s
Disease Foundation, and the Bernard and
Anne Spitzer Fund.
— Susan Conova
Y O U N G
F A C U L T Y
P U B L I C
H E A L T H
Craniofacial Surgeon on Mission
To Improve Young Lives
Understanding HIV Risk
in Married Women
F O R J U N E W U O F T H E C L E F T / C R A N I O FA C I A L C E N T E R , A M E D I C A L M I S S I O N T O C H I N A
HIV infection among women worldwide. Now, an
A D D S A G L O B A L P E R S P E C T I V E T O H E R W O R K W I T H C H I L D R E N W I T H FA C I A L D E F E C T S
NIH-funded collaborative study including the
Marital sex is known to be a leading risk factor for
Mailman School of Public Health reveals that cultur-
B
read and butter surgery,” is how
June Wu, M.D., assistant professor of surgery, describes the cleft
lip and palate surgeries she performed
during her first medical mission to China
recently. But what is routine for Dr. Wu
has turned out to be life-changing for
two of her young patients in Xian, who
are in the process of being adopted from
the orphanage in which they live.
“We treat the most disadvantaged
segment of society – the babies and children who can’t advocate for themselves,”
Dr. Wu says. “This operation gives them
a better chance of being adopted, or at
the very least improves their appearance
so they can integrate into society.”
Dr. Wu, P&S’96, went to China this
past May when Jeffrey Ascherman, M.D.,
associate professor of clinical surgery
and director of the Cleft/Craniofacial
Center at CUMC, was unable to make
what would have been his seventh overseas medical mission. “I wasn’t originally
supposed to be the physician going on
this mission, but the experience sold me
on the idea of going on more of them,”
Dr. Wu says.
Conditions in China were challenging. Children with cleft lip or palate are
often more severely disfigured there than
in the United States, because their problem has often been neglected. A child
born with a severe cleft lip and palate in
the United States may be fitted within a
few weeks after birth with a retainer that
slowly forces the two sides of the palate
together. By the time surgery is performed, when the baby is between 3 to 6
months old, the sides are in a more normal position. This reduces the size of the
cleft and makes the operation somewhat
less difficult. It also reduces the chances
that the repair will pull apart after surgery, and improves facial aesthetics. But
on her trip Dr. Wu saw children as old as
two, whose clefts, without treatment,
had continuously enlarged.
These were trying conditions for any
surgeon, but particularly for one who is
accustomed to spending an hour at the
beginning of an operation painstakingly
delineating her surgical plan – the blueprint for the operation – on a patient’s
face. “I suppose I’m a bit of a perfectionist,” she says.
Dr. Wu also has an artistic sensibility
that infused her choice of medical specialty. “I knew in my first year of medical
school that I wanted to be a plastic surgeon. I like plastic surgery because it’s
not just technical, there’s an artistic component,” she says.
After medical school, Dr. Wu completed an integrated general and plastic
surgery residency at Montefiore and was
“
al expectations and changing attitudes about love
and marriage encourage male infidelity.
Jennifer Hirsch, Ph.D., associate professor of
sociomedical sciences and lead author, conducted
the six-month study in a rural Mexican village. She
found that the forces that promote extramarital sex
– access to alcohol and women; patterns of economically driven mobility; and the segregation of
men’s and women’s “spheres” in society and in family life – are pervasive and extremely powerful.
While the overall HIV infection rate in Mexico is
low at 0.3 percent, certain groups have higher levels. In returning migrants, for example, infection
rates are as high as about 1 percent because many
men travel to areas such as New York City, where
HIV-prevalence is much higher and where they
engage in unsafe extramarital sex during their long
absences. When migrant workers return to their
Mexican wives, they are said to be on their honeymoon and resume marital sexual relations.
June Wu performs surgery in China.
drawn to pediatric craniofacial surgery.
“Plastic surgery is often associated
with adults trying to achieve a flawless
appearance,” Dr. Wu says. “But for children, plastic surgery often helps a child
look more average. In many cases, children would be shunned and never able to
function normally in society without
surgery. Surgery puts them on a level
playing field and also relieves the heavy
emotional toll on the family.”
After finishing her fellowships in
craniofacial surgery and vascular anomalies at Children’s Hospital of Boston,
Dr. Wu was recruited to Columbia by Dr.
Ascherman two years ago.
“I’ve known June since she was a
medical student, and when we started
expanding the pediatric surgery program, I knew she would be a wonderful
addition,” Dr. Ascherman says. “June is
very committed to children, and since
she began, she’s been a very important
part of our team.”
Dr. Wu is already planning to return
to China next year, both to treat children
and help her Chinese colleagues learn
the latest surgical techniques.
“The trip was definitely a learning
experience for me,” Dr. Wu says. “The
conditions are very different and challenging, but the work is extremely
rewarding. I’m very much looking forward to going back.”
“Women are infected by their returning husbands, the very people with whom they are supposed to be having sex and, according to social conventions of Mexico, the only people with whom they
are ever supposed to have sex,” says Dr. Hirsch.
Dr. Hirsch collaborated with anthropologists
from Brown, University of Toronto, University of
Washington, and Washington University who
worked at sites from New Guinea to Vietnam and
reported similar findings. These findings have farreaching implications for public health policy, especially with respect to U.S. funding for AIDS prevention, which requires that a third be spent teaching
— Susan Conova
abstinence and monogamy. “If you tell people to
Center’s Team Approach Ensures
Best Results for Cleft Lip and Palate Defects
For the approximately 1 in 700 children born with cleft lip or palate in the United States,
a team of specialists is often required to repair the defect and obtain the best possible outcome. Since such children usually speak with nasal intonations that may be hard to understand, speech therapists usually begin working with the child as soon as he or she begins
to speak. Otolaryngologists manage the frequent ear infections many children experience
because of malfunctioning Eustachian tubes. And oral surgeons graft bone into the gumline when bone is lacking, to hold the child’s permanent teeth in place as they grow in.
The Cleft/Craniofacial Center at CUMC coordinates such care among all specialists. The
center was created in 1994 by Jeffrey Ascherman, M.D., associate professor of clinical surgery and the center’s director. Since then, center physicians have treated hundreds of children with cleft lip/palate and other craniofacial abnormalities.
be abstinent until marriage, but their greatest risk
of HIV infection actually comes after marriage, it’s
not useful advice,” says Dr. Hirsch.
Dr. Hirsch recommends making condoms available in places where men are likely to meet partners for extramarital sex and exploring ways that
migration policies contribute to marital risk. “We
found that it’s not as if there are men who engage
in extramarital sex and men who don’t. There are
contexts in which all men are much more likely to,”
she says. “We have to do a better job of thinking
about what those contexts are, and working within
that framework.”
5
M A I L M A N
S C H O O L
R E S E A R C H
B R I E F S
R E S E A R C H
In Search of the
Honeybee Killer
The potentially devastating phenomenon known as
colony collapse disorder (CCD), which is decimating
bee hives across the country, has received much publicity lately. Now, W. Ian Lipkin, M.D., the Jerome L.
and Dawn Greene Professor of Epidemiology at the
Mailman School of Public Health, who is part of a
consortium actively investigating CCD, says the
group may have found a pathogen responsible for
die-offs in the majority of colonies.
Bees are integral to the world’s food supply, pollinating more than 90 primary agricultural crops valued at about $15 billion.
Colony collapse disorder is not a new phenomenon, but it is occurring at an unprecedented rate.
Beekeepers began reporting major losses in
November 2006. As of April, more than a quarter
of bee colonies in the United States were lost with
no signs of abatement. The honeybees in stricken
colonies often simply vanish, leaving only a few
workers and a queen behind.
Scientists have many theories as to a possible
cause of CCD. Everything from electromagnetic radiation to stress to an infectious agent has been cited. Dr.
Lipkin, who headed the lab that discovered West Nile
virus in 1999, has the task of teasing out the infection
piece of the puzzle, using the same high-throughput
DNA analysis that he uses to identify viruses, bacteria
and parasites behind human diseases.
Single Protein May I.D.
Aggressive Cancers
The most aggressive breast cancers may be
detected by the levels of a single protein
called stathmin, according to a new study
led by Ramon Parsons, M.D., Ph.D., the
Avon Foundation Professor of Pathology
and Medicine, and Åke Borg of Sweden’s
Lund University.
In a retrospective analysis of samples
from tumor banks, the researchers found
that survival after diagnosis for breast cancer
declines 8 percent to 16 percent for every
one point increase in stathmin activity, which
is scored on a scale from 0 to 12.
“Patients with these types of aggressive
biophysics and in neuroscience, the study
tumors have few good treatment options
found that the “Met” form of BDNF pre-
and there is a real need for effective drugs,”
vents inactive neurons from withering away
says the study’s first author, Lao Saal,
during brain development. BDNFmet – in
P&S’09. “The good news is that inhibiting
which a methionine amino acid replaces the
the PI3K/PTEN pathway has enormous
more common valine at position 66 in the
potential for improving survival and there
protein – is present in about 10 percent of
are many attractive therapeutic targets in
the population.
the pathway that may be exploited.”
The study focused on the olfactory bulb.
Because microarrays are expensive and
The advantage of this brain region is that
hard to use in clinical settings, the
during the initial wiring of the sense of
researchers also looked for a simpler way to
smell, thousands of neurons compete
detect PI3K/PTEN defects. Simple immun-
against each other for access to a few
odetection of stathmin proved an accurate
hundred cells. Active neurons have the
surrogate for the full signature and may
advantage in this competitive playing field.
evolve into a clinically useful diagnostic test.
BDNFmet reduces this competition and
The research was supported, in part, by the
lets more inactive neurons gain access to
NIH and the Avon Foundation.
the cells in the olfactory bulb, the
Neuronal Competition
Leads to More
Psychiatric Disorders
researchers found.
had been unclear because previous assays
Children born with an uncommon form of
could not detect all defects in the pathway.
the brain. Dr. Gogos says that one way
a certain brain protein are approximately
The new study identified a group of 246
BDNFmet may protect against these disor-
50 percent less likely to develop obsessive-
genes that form a genetic microarray signa-
ders is by allowing more neurons to survive
compulsive disorder, depression and other
ture that detects aberrant PI3K/PTEN path-
the competition.
psychiatric diseases during childhood.
The work was supported by the NIH, a
way activity. Breast, prostate, and bladder
A new study by CUMC researchers now
Burroughs Wellcome Fund Career Award in
cancers exhibiting this signature had very
shows why this form of brain-derived neu-
the Biomedical Sciences, the Whitehall
poor prognosis, confirming the PI3K/PTEN
rotrophic factor (BDNF) may be so protective.
Foundation and NARSAD: The Mental
Stathmin predicts survival, the researchers
found, because it mirrors the activity of an
entire molecular pathway inside cancer cells.
When active, the PI3K/PTEN pathway promotes tumors in model systems. But its
prognostic significance in human cancers
pathway has a major impact on patients.
Led by Joseph Gogos, M.D., Ph.D.,
Psychiatric disorders in children may
stem from an excessive loss of compromised
neurons during competition in other parts of
Health Research Association.
assistant professor of physiology and cellular
Dr. Lipkin joined the investigation in December at
the request of Dr. Diana Cox-Foster, a scientist at Penn
State who is coordinating a nationwide team of CCD
researchers that includes scientists from Penn State,
Garvey Education Grants
continued from Page 2
Columbia, the University of Arizona and the USDA. “I
was initially hesitant to sign on because bees are not
among the organisms we normally study,” Dr. Lipkin
P E N E L O P E B U S C H M A N G E M M A , M . S . , A P R N , assistant professor of clinical nursing; Marlene McHugh, M.S., FNP, assistant pro-
fessor of nursing; and Anita Nirenberg, M.S., NP, assistant professor of clinical nursing, School of Nursing. “Creating an Educational Partnership
says. “But Dr. Cox-Foster was persuasive. After discussions with the pathogen discovery team here –
Thomas Briese, Gustavo Palacios, Lan Quan and Sean
in Palliative and End of Life Care.”
K AT H L E E N
H I C K E Y,
F N P,
A N P,
ED.D.,
assistant professor of nursing, School of Nursing. “REAL: Remote Electronic
Conlan – we jumped in with both feet.”
The Greene Lab joined a formidable research initia-
Arrhythmia Learning.”
tive. “This is the largest single effort to address CCD,”
Dr. Lipkin says. “The researchers meet by phone every
three days, and smaller groups are in constant contact
P A T R I C I A M I L L E R , E D . D . , associate professor of clinical rehabilitation medicine, and Mathew Maurer, M.D., Herbert Irving Assistant
Professor of Clinical Medicine, P&S. “Facilitating Change to Promote Health in Older Adults: An Interdisciplinary Education Program.”
throughout the day. The result is that the project, just
eight months old, is moving very rapidly.”
Early on, the consortium determined that infec-
LY N N E
QUITTELL,
M . D . , clinical professor of pediatrics, P&S,. “Intercontinental Real Time Global Health Teaching: Creating
University Synergies – A Model for the Future.”
tious agents must play a critical, if not exclusive, role
in CCD. To determine this, they looked at repopulation of affected hives. Ordinarily, bees will recolonize
T R A N S P L A N T A T I O N
C E L E B R A T I O N
abandoned hives, but those that have succumbed to
CCD are rendered untouchable. However, if combs
from CCD hives were irradiated, the bees would
repopulate the combs, pointing to an infectious
pathogen. A non-biological agent would not have
dissipated with irradiation.
The next challenge was to positively identify that
pathogen. Materials were collected from hives
affected by CCD as well as from still-healthy hives.
Using high throughput genetic analysis and applying
algorithms that allowed them to identify possible
culprits, the researchers screened for all types of
infectious agents: bacteria, viruses, parasites, mites,
and fungi. They then compared the genetic profiles
of the suspicious targets across individual colonies in
search of the “smoking gun” that was present in
affected colonies but absent in healthy colonies.
Once the pathogen is definitively identified, the
plan is to develop strategies to outsmart it, perhaps
by developing transgenic bees that are resistant to
6
Nearly 1,000 organ transplantation patients, donors and their families reunited with their medical teams at the West 168th Street
Armory in May to celebrate a second chance at life. Columbia physicians are working on many fronts to improve clinical outcomes
and quality of life for those who need transplants. In lung transplants, for example, the Center for Lung Disease and Transplantation
has pioneered scientific investigations to better understand and treat major post-transplantation complications. In heart transplants,
infection, drugs to treat it, and tools for surveillance
a major focus is in the area of left ventricular assist devices (LVADs). Kidney transplantation, liver regeneration, and mechanisms that
to facilitate containment.
affect diseases of the pancreas are other areas receiving research attention.
HIV Battlefront
continued from Page 1
lished to carry out the next generation of
HIV/AIDS vaccine, prevention, and
treatment research.
Drs. Hammer and El-Sadr have been
fighting AIDS since the epidemic began
in the early 1980s, when patients filled
hospitals with a mysterious disease that
had no known cause, no treatment, and
no hope for survival.
Though the outlook for people with
HIV in the United States has dramatically improved since then, New York City is
still the epicenter of the HIV/AIDS epidemic in this country. More than
100,000 New Yorkers are living with HIV
and the city has more AIDS cases than
San Francisco, Los Angeles, Miami and
Washington D.C., combined.
Progress in further reducing the
spread of the virus has also stalled, and
in some groups infections are on the rise.
Among young gay men of color in New
York City and several other urban areas
in the United States, the virus is spreading at a rate twice that in Uganda.
The trends in New York City reflect
what is happening across the country:
More and more women are getting HIV,
and blacks and Latinos are disproportionately affected.
Inner Cities See HIV Rise
“Cities in the United States with disenfranchised populations face similar
problems,” Dr. Hammer says. “Our inner
cities present us in some respects with
our own ‘developing world’ challenges.”
The
Columbia
Collaborative
HIV/AIDS Clinical Trials Unit gives people with HIV in northern Manhattan allimportant access to clinical trials. The
unit conducts clinical trials for drugs to
treat AIDS itself, as well as the co-infections that are common among people
with HIV, and the debilitating side
effects of current AIDS treatments.
Clinical trials give patients access to
new drugs and new strategies to make
treatments more effective, more durable
and more tolerable,” Dr. Hammer says.
“The advances we’ve seen to date would
not have been possible without a commitment on everyone’s part to a strong
clinical research effort.”
With medical care integrated into the
research clinics, trial participants receive
the best HIV treatment available.
“We don’t just recruit people for
studies. We reach out to the community
to get important feedback, to learn what
kinds of studies they want to see, and to
provide useful information to help people protect themselves and maintain
their health,” Dr. Hammer says. “We
enter into partnerships with HIV-infected patients and strive to provide them
with decades of survival. Our goal is a
full, productive life for people with HIV
infection; the disease can now be considered chronic and manageable over the
long-term.”
Despite the effectiveness of today’s
antiretroviral drugs, vaccines remain the
best chance of ultimately beating HIV.
The Columbia Collaborative HIV/AIDS
Clinical Trials Unit – the only NIHfunded HIV Vaccine Trials Network site
in the city (in collaboration with the
New York Blood Center and principal
investigator, Dr. Beryl Koblin) – is currently testing vaccines in Phase I and II
trials, including early efficacy trials. The
current generation of vaccine candidates
may not prevent HIV infection, but may
alter its course once an individual
becomes infected.
“We hope these vaccines can slow the
progress of the disease in someone who
becomes infected,” Dr. Hammer says. “By
reducing the amount of virus in the
body, the vaccines may also help reduce
further transmission in the population.”
Since a vaccine that completely prevents infection may be a decade or more
away, the Center for Innovative Research
to Control AIDS will continue Dr. ElSadr’s efforts to identify other means of
prevention, including vaginal microbi-
cides that would give women more control over prevention. Other efforts
include behavioral interventions and the
use of antiretroviral drugs as a means to
prevent acquisition of HIV.
“Even with a vaccine available, other
prevention strategies should still be useful,” Dr. El-Sadr says. “One intervention
will not bring the transmission rate
down to zero, so there is room for a
menu of effective preventions, with
A W A R D S
&
H O N O R S
Columbia President Lee Bollinger, Provost Alan
Brinkley and the Trustees have approved a $2
million initiative from the Professional Schools’
Diversity Council to help diverse junior faculty develop
scholarly profiles to become eligible for tenure.
Departments can apply for funds for research grants to
some targeted to specific populations.”
support the scholarly work of untenured colleagues.
Goal: Learn Status/Receive Care
The CUMC recipients and their projects: L U I S A
One big impediment to prevention
strategies that is often forgotten, Dr. ElSadr says, is the large numbers of people
– about one in four in New York City –
unaware that they are infected with HIV.
Because most HIV infections are transmitted by people who do not know they
have the virus, simply increasing the
number of people who know their status
may significantly reduce the spread.
Such knowledge coupled with behavioral interventions can go a long way to
stemming the spread of HIV.
“Studies show that people who know
their status adopt appropriate behaviors
to reduce the spread of the virus,” Dr. ElSadr says. “People who find out they’re
negative are motivated to adopt behaviors to stay that way. And people who are
positive adopt behaviors to prevent
spread to others.”
The advent of rapid HIV tests that
can produce results in 10 minutes has led
Dr. El-Sadr to introduce testing in nontraditional settings, including emergency
departments, in outpatient and inpatient
services at Harlem Hospital Center, and
at community street fairs.
“When we find people who are positive, counselors take them by the hand to
the clinic and we assure them we will
take care of them,” Dr. El-Sadr says.
“We’re always surprised by the number
of individuals we find who never suspected that they had HIV.”
— Susan Conova
BORELL,
PH.D.,
D.D.S.,
assistant
M . P. H . ,
professor of epidemiology and assistant professor of
dentistry, to investigate health disparities within
Hispanic
communities;
GEORGE
JENKINS,
D . M . D . , assistant professor of clinical dentistry, to
start research into the triage population at the College
of Dental Medicine to allow for better needs assessment of the community being served and the identification of health problems associated with particular
populations; K A T H I E - A N N
JOSEPH,
M.D.,
assistant professor of surgery, to determine what biological mechanisms impact breast cancer recurrence
and survival rates in African-American women; N A A
OYO
K W AT E ,
PH.D.,
assistant professor of
sociomedical sciences, to research the health effects
of residential racial segregation or mixed living areas
on minority health; P E T E R
M . P. H . ,
MUENNIG,
M.D.,
assistant professor of health policy and
management, to research qualitative properties of
stress and how prestige affects the stress response;
MIGUEL
M U N O Z - L A B O Y,
M . P. H . ,
DR.PH,
assistant professor of sociomedical sciences, to investigate sexual risk behaviors among bisexual Latino
women and men; G U S T A V O P A L A C I O S , P H . D . ,
assistant professor of clinical epidemiology, to further
his research on the importance of environmental triggers in individuals genetically disposed to disease,
Columbia HIV/AIDS Clinical Research Sites
especially the role of viruses in the development of
The research led by Drs. Hammer and El-Sadr is not possible without collaboration with other researchers who bring a wealth of
type-1 diabetes mellitus; D E A N P R E D D I E , M . D . ,
expertise and have gained the trust of their communities. Clinical research sites and their leaders are listed below.
assistant professor of clinical medicine, for a pilot proj-
n
HIV Prevention and Treatment Research, CUMC, PI: Scott Hammer, M.D. (treatment, vaccine trials)
ect on home dialysis in preparation for establishing a
n
Harlem Family Center, Harlem Hospital, PI: Wafaa El-Sadr, M.D. (treatment and prevention trials)
home hemodialysis program at Columbia; C A R L O S
n
New York Blood Center, Bronx, PI: Beryl Koblin, Ph.D. (vaccine and prevention trials)
R O D R I G U E Z , M . D . , M . P. H . , assistant professor
n
New York Blood Center, Union Square; PI: Beryl Koblin, Ph.D. (vaccine and prevention trials)
of clinical medicine and clinical epidemiology, to
n
IMPAACT at CUMC; PI: Philip LaRussa, M.D., professor of clinical pediatrics (maternal, pediatric and adolescent treatment and
research cardiovascular disease in Hispanic popula-
prevention trials)
tions; D I A N A R O M E R O , P H . D . , assistant pro-
n
University of Medicine & Dentistry of New Jersey, PI: Sally Hodder, M.D. (prevention trials)
fessor of population and family health, to conduct sec-
n
Bronx-Lebanon Hospital Center, PI: Jessica Justman, M.D., assistant professor of clinical medicine (in Epidemiology)
ondary analyses of the National Survey of Family
(microbicide trials)
Growth to explore social and economic status as it
relates to sexual and reproductive health and family
growth; I L Y A S W A S H I N G T O N , P H . D . , assistant
professor of ophthalmic science, to launch research on
age-related
macular
degeneration;
PAT R I C K
W I L S O N , P H . D . , assistant professor of sociomedplease see Page 8
7
A W A R D S
&
H O N O R S
Nursing Leader
continued from Page 1
continued from Page 7
ical sciences, to examine situational factors that promote high-risk sex among HIV-positive men who have
sex with other men.
L E E G O L D M A N , M . D . , executive vice president,
was awarded the 2007 John Phillips Memorial Award
by the American College of Physicians (ACP) at the
college’s annual medical education meeting in San
Diego in April. The award is bestowed for outstanding
work in clinical medicine, including all phases of clinical research or the practice of medicine. The award
was established to honor Dr. Phillips, the late governor and regent of the ACP.
J E S S I C A K A N D E L , M . D . , associate professor of
surgery, has been elected a member of the American
Surgical Association. She joins others from the department who are already members.
JENNIFER
LEVINE,
M.D.,
M . S . W . , a pedi-
atric oncologist and medical social worker, has been
named an CureSearchAflac Young Investigator in
Adolescent and Young Adult Oncology for 2007-2009.
J E F F R E Y L I E B E R M A N , M . D . , chairman of the
Department of Psychiatry at P&S and director of the
New York State Psychiatric Institute, received the 2007
Adolph Meyer Award at the American Psychiatric
Association (APA) meeting in May. The award is APA’s
kind in the world. Now, about 200
schools nationwide are setting up clinical doctorate programs, in the wake of
an October 2004 position statement
from the American Association of
Colleges of Nursing that called for moving the current level of preparation
required for advanced nursing practice
roles from the master’s degree to the
doctorate level by the year 2015.
An urgent need for nurses with such
advanced training is necessary in light of
looming practitioner shortages. Almost
all states will have a shortage of primary
care physicians by 2020, according to a
2006 report from the American
Academy of Family Physicians.
“Normally, nurse practitioners care
for patients in ambulatory care settings,”
says Judy Honig, DrNP, EdD, CPNP-PC,
who directs the Doctor of Nursing
Practice program. “These nurses will
be uniquely prepared as primary care
providers to see patients across a variety
of settings. With more chronic illness
and an aging population, there’s a growing need for more primary care, and the
DrNP will be qualified to provide that.”
It’s all part of a sea change for nursing
as a profession – a change in which
Columbia is playing a critical role. “We
have the largest number of applicants to
the School of Nursing that we’ve ever
had, and they are entering because of the
way the profession is evolving,” says
Jennifer Smith, DrNP, M.P.H., M.B.A.,
senior associate dean. “Nurses are changing the face of health care.”
The stage was set for nurses’ evolving
role as primary care providers by programs like Columbia Advanced Practice
Nurse Associates (CAPNA), the innovative nurse practitioner-run practice
based at East 60th Street.
While other nurse practitioner-run
primary care practices were already in
existence when CAPNA opened its doors
in 1998, the program differs from most
others in that its nurse practitioners are
reimbursed at the same rate as doctors.
They also have admitting privileges to
New York-Presbyterian Hospital. These
faculty advanced practice nurses diagnose
and treat illness and perform physical
exams and tests, making nearly 80 referrals per month to Columbia specialists.
“We are well regarded by CUMC
physicians,” says Dr. Smith. “That we’ve
thrived for 10 years is a testament to the
kind of care we deliver, as everyone in
New York wants to go to the best specialist. But it’s so hard to find primary care
now that we fill a niche with our focus on
prevention and education. In the long run
this not only helps patients live healthier
lives, but also saves money. And when
patients who have insurance have a choice
and choose us, that really says something.
They like the kind of health care our
nurse practitioners are able to give.”
Just two decades ago, Columbia’s
School of Nursing was struggling with
low enrollments and the changing role of
women in the workforce – particularly
difficult for a profession that is still primarily female. But Mary O’Neil
Mundinger, DrPH, RN – appointed dean
in 1986 – brought the school roaring
back. She required all nurses on the fac-
highest honor. Dr. Lieberman received the award for
his stellar and outstanding contributions to the
ulty to either have a faculty practice or a
program of research. That attracted
experienced clinicians and researchers,
who stepped into the classroom to teach
what they loved, and soon Columbia
began accumulating an impressive list of
accomplishments:
n
n
n
n
n
the first randomized trial comparing
nurses and physicians in primary
care – and demonstrating that
health outcomes were equal
the highest per capita NIH faculty
research funding
the first and only nursing school to
be designated a World Health
Organization collaborating Center
for the International Nursing
Development of Advanced Practice
the first and only Nurse Principal
Investigator in the NIH’s priority
funding to establish 21 translational
research centers
the first nursing school faculty to
gain admitting privileges at a major
teaching hospital
Today, students and faculty at the
SON practice at more than 200 sites in
New York City, applications to the school
are up 30 percent and the program ranks
13th in NIH research funding – up from
27th in 2005.
“The new nurse is a researcher, a
teacher, and a practitioner,” says Dr. Smith.
“Nurses are helping to drive changes in
health care, with an understanding of the
importance of a focus on quality, education and prevention. Columbia is in the
forefront of that movement.”
— Gina Shaw
Advances in Nursing Research
advancement of psychiatry through research.
School of Nursing faculty are among the nation’s most prominent researchers in the field. They also participate in interdisciplinary teams with
P A N O S P A P A P A N O U , D . D . S . , P H . D . , profes-
sor of dentistry and director of the Division of
faculty from medicine, neurology, ophthalmology, public health and bioinformatics and are the recipients of multiple NIH funded grants.
n
Suzanne Bakken, DNSc, R.N., Alumni Professor of Nursing and professor of medical informatics, a nationally known expert in bioinfor-
Periodontics, has been elected councillor of the
matics, has received more than $1 million in federal research grants this year alone. Her study, “Wireless Informatics for Safe and
Periodontal Research Group of the International
Evidence-based (WISE) APN Care,” is supported by the Health Resources and Services Administration. The National Cancer Institute
Association of Dental Research.
awarded her a grant to study integration of resources from the Institute’s Cancer Information Service into an existing PDA-based
mobile decision-support system.
B R I A N S C U L L Y , M . D . , professor of clinical med-
icine and infectious diseases and L U C I E N C O T É ,
n
M . D . , special lecturer in neurology, Gertrude H.
Centers for Disease Control and Prevention. Her expertise in infection control was recently recognized with a $2 million, two-year grant
Sergievsky Center, have been chosen by CUMC’s
Society
of
Practitioners
to
receive
its
Elaine Larson, Ph.D., R.N., professor of pharmaceutical and therapeutic research, has received multiple awards from the NIH and the
from the CDC for a study of non-pharmaceutical interventions for pandemic influenza.
2007
n
Joyce Anastasi, Ph.D., DrNP, R.N., FAAN, LAc., Helen F. Pettit Professor of Clinical Nursing, is a renowned expert in HIV/AIDS. Her
Distinguished Practitioner Awards. The awards were
research focuses on symptom management and the use of alternative therapies to complement traditional interventions for patients
presented at the society’s June meeting. Both were
with HIV and has been funded by the NIH for more than 10 years.
honored for their clinical expertise, contributions to
clinical medicine, and the inspirational roles they have
played for clinicians and students.
n
Mary Woods Byrne, Ph.D., M.P.H., CPNP, professor of nursing and the Stone Foundation and Elise D. Fish Professor of Clinical Health
Care for the Underserved, runs a federally funded research program focused on the assessment and early intervention for infants,
toddlers and children and their caregivers at risk for sub-optimum development and inadequate parenting. Her current NIH-funded
P E T E R S H A P I R O , M . D . , associate professor of
research focuses on parenting and child outcomes in a prison nursery.
clinical psychiatry and associate director of the
Psychiatric Consultation/Liaison Service at NYP, has
Save the Date: White Coat Ceremonies
received the 2007 Bakken Award from the Bakken
The College of Physicians & Surgeons
The College of Dental Medicine
Time: 12:30 p.m.
Time: 2:00 p.m.
Date: Aug. 24, 2007
Date: Aug. 24, 2007
Location: Alumni Auditorium, P&S building, 630 W.168th St.
Location: Rm. 401, Hammer building, 701 W. 168th St.
Heart-Brain Institute of the Cleveland Clinic.
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